Volume 2 Issue 3

Research Article: Which is More Important to Cerebral Blood Flow in Children with Vasovagal Syncope: Heart Rate or Blood Pressure?

Wang Hong*, Xing Yanlin, Chen Rui, Wang Ce, Yu Xuexin, Sun le, Xu Yunming, Li Xuemei, Chu Yanqiu and Pan Xiaoli

Objective: The mechanism of Vasovagal Syncope (VVs) is transient cerebral insufficient blood flow. It results in short unconsciousness and failed to maintain body posture. Once the cerebral blood flow decrease, the cerebral wave becomes slow. To exploring the effects of Heart Rate (HR) and Blood Pressure (BP) at syncope, we recorded the cerebral wave using Ambulatory Electroencephalogram (AEEG) in children during the Head-Up Tilt Test (HUTT).
Methods: Total 152 children from the pediatric department of Shengjing Hospital, China Medical University were enrolled between January 2008 and March 2016. Serum biomarker tests, Electroencephalogram (EEG), Transcranial Doppler (TCD) and head Magnetic Resonance Angiography (MRA) or head Computed Tomography (CT) was examined. HUTT was performed concomitantly with AEEG. The endpoint was undergoing the HUTT for 45 minutes or the occurrence of syncope/pre-syncope. Sublingual nitroglycerin provocative test (4-6 μg/kg, max 300 μg) (SNHUTT) was followed HUTT for 20 minutes or the occurrence of syncope/pre-syncope.
Results: AEEG was performed in 107 patients. Ninety one AEEG was synchronous with HUTT, while 16 AEEG performed before HUTT. Abnormal AEEG was found in 10 patients HUTT/SNHUTT positive in 9 patients. Among them four with symmetrical high amplitude slow wave were found in bilateral cerebral hemispheres at the moment of syncope/pre-syncope occurred during HUTT (3 vasodepressor and one mixed depressor) and disappeared as soon as they prostration. Four with unsymmetrical spike waves at sleeping and one with sleep disorder at no-syncope period. The other one was HUTT negative but with slow waves at all day. Eighty four patients were positive in HUTT/SNHUTT, while 18 were negative despite undergoing HUTT and SNHUTT. Vice Sinusitis was accidentally found on MRA in 10 patients. Four with vasodepressor, two mixed depressor, One Postural Tachycardia Syndrome (POTS), one undefined and two negative.
Conclusions: Hypotension may play a more important role than HR in cerebral hemodynamic when VVs occurred during HUTT. Sinusitis may induce VVs. AEEG is an important method to distinguish the syncope with unconsciousness or convulsion during HUTT.

Cite this Article: Hong W, Yanlin X, Rui C, Ce W, Xuexin Y, et al. Which is More Important to Cerebral Blood Flow in Children with Vasovagal Syncope: Heart Rate or Blood Pressure? Int J Cardiovasc Dis Diagn. 2017;2(3): 058-064.

Published: 28 December 2017

Case Report: Acute Coronary Syndrome Resulting From Compression of Left Main Coronary Artery Secondary to Pulmonary Aneurysm Expansion

Jiang Y. Wang, Han Chen*, Xi Su, Chen W. Liu, Dan Song, and Hua Yan

A 51-year-old man presented to the emergency department with intermittent, nonexertional chest pain of 10 days' duration. Symptoms of chest pain were aggravated when the patient was on the left side. At 18 years of age, he had been diagnosed with a "hole in his heart" in the local hospital. His parents had declined options for treatment. On the Electrocardiogram (ECG) at emergency room, signs of acute myocardial infarction in the anterior territory were presented with ST depression in leads V1 to V6 and elevated in leads AVR, I, II. Troponin I concentration was 3.28 ng per milliliter (reference range, 0 to 0.03ng per milliliter).

Cite this Article: Wang JY, Chen H, Su X, Liu CW, Song D, et al. Acute Coronary Syndrome Resulting From Compression of Left Main Coronary Artery Secondary to Pulmonary Aneurysm Expansion. Int J Cardiovasc Dis Diagn. 2017;2(3): 055-057.

Published: 07 October 2017

Case Report: Spontaneous Abdominal Hematoma in a Patient Treated With Ticagrelor and Aspirin

Jiang Y. Wang, Xi Su*, Chen W. Liu, Chen YiXu, Zhi P. Zhang, Dan Song, JianPeng and Hua Yan

Spontaneous Retroperitoneal Hematoma (SRH) is a potentially fatal and difficult to diagnose clinical entity defined as bleeding into the retroperitoneal space without associated trauma or iatrogenic manipulation. We present a case of spontaneous retroperitoneal hemorrhage after acute myocardial infarction involving anticoagulant agents.

Cite this Article: Wang JY, Su X, Liu CW, YiXu C, Zhang ZP, et al. Spontaneous Abdominal Hematoma in a Patient Treated With Ticagrelor and Aspirin. Int J Cardiovasc Dis Diagn. 2017;2(3): 052-054.

Published: 30 September 2017

Letter to Editor: Could Comorbidities Contraindicate Cardiac Resynchronization Therapy Devices Implantation?

Laura Ajello*, Gregory Dendramis, Egle Corrado, Gianfranco Ciaramitaro, Pasquale Assennato, Salvatore Novo and Giuseppe Coppola

Cardiac Resynchronization Therapy (CRT) is a valuable therapy for Heart Failure (HF), that has proved effective not only in improving symptoms, exercise capacity, quality of life (QoL) and systolic function of the Left Ventricle (LV), but also in determining an increase in survival and a reduction of hospitalizations for exacerbations of HF. However only 70% of patients respond favorably to such treatment, attracting therefore the attention on the appropriateness of indications and correct selection of patients, also in relation to comorbidities.
Cardiac Resynchronization Therapy (CRT) has proved to be effective not only in improving symptoms, exercise capacity, Quality of Life (QoL) and systolic function of the Left Ventricle (LV), but also in determining an increase in survival and a reduction of hospitalizations, among patients with Heart Failure (HF). However, the data obtained from the various studies on CRT have shown that only 70% of patients respond favorably to such treatment, attracting therefore the attention on the appropriateness of indications and correct selection of patients, also in relation to comorbidities that can both make the implantation difficult and impair its long-term benefit. In patients undergoing CRT, in a single-center observational study, the prevalence of COPD, CKD and diabetes resulted respectively of 27.7%, 65.2% and 33.8%, while in patients aged >75 years the prevalence of these comorbidities was respectively of 40%, 82% and 31.3% [1].
Most of the patients have many comorbidities and the burden of comorbidities correlate with an increased mortality.

Cite this Article: Ajello L, Dendramis G, Corrado E, Ciaramitaro G, Assennato P, et al. Could Comorbidities Contraindicate Cardiac Resynchronization Therapy Devices Implantation? Int J Cardiovasc Dis Diagn. 2017;2(3): 049-051.

Published: 27 September 2017

Research Article: Simplified Method for Isthmus Block Assessment in Atrial Flutter Ablation: Results of a Single Center Experience

Mathieu Granier*, Xavier Brunet, Guillaume Cayla and Pierre-Francois Winum

Background: Typical Atrial Flutter (AFl) is standardly cured by Radiofrequency (RF) ablation with the goal of Cavo-Tricuspid Isthmus (CTI) block. Here we describe our method to assess CTI block and its result on clinical recurrence.
Methods: CTI ablations performed at our center were analyzed. We used two catheters: a quadripolar in the coronary sinus (Cs) and the RF catheter.
The endpoint of ablation was the assessment of isthmus block if S-A2 interval was > 140 msec, measured from the Cs ostium (S) to the RF catheter placed lateral to the CTI (A2). We aimed to study the rate of recurrence after a maximal follow up of 24 months.
Results: 74 patients were included (age 69.8 ± 11). Post procedural S-A2 interval was 162 ± 26 msec. S-A2>140 msec was achieved in 66 patients (89%). Eight patients (11%) exhibited a S-A2 <140 msec but >130 msec. One patient exhibited a S-A2=110 msec and flutter recurrence after 13 months.
During follow-up (14.1 ± 6.8 months), 4 patients were lost. Flutter recurred in 3 (4%). AFl-free and arrhythmia-free survival probabilities were respectively 84% [CI 0.71-0.99] and 54 % [CI 0.36-0.80]. Fifteen patients (21.5%) developed AF.
Conclusion: In our cohort, assessment of CTI block by a S-A2 interval >140 msec is feasible with a rate of recurrence of 4%. This cut-off value seems relevant but would deserve a comparative analysis. This simplified approach is safe and effective with clinical results comparable to the literature.

Cite this Article: Granier M, Brunet X, Cayla G, Winum PF. Simplified Method for Isthmus Block Assessment in Atrial Flutter Ablation: Results of a Single Center Experience. Int J Cardiovasc Dis Diagn. 2017;2(3): 043-048.

Published: 19 September 2017

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